Provider Demographics
NPI:1245594217
Name:DAWSON, SHIRLEY NONE (MD)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:NONE
Last Name:DAWSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1869A LAFAYETTE AVE
Mailing Address - Street 2:78
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10473-2865
Mailing Address - Country:US
Mailing Address - Phone:917-570-1699
Mailing Address - Fax:
Practice Address - Street 1:1869A LAFAYETTE AVE
Practice Address - Street 2:78
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10473-2865
Practice Address - Country:US
Practice Address - Phone:917-570-1699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-25
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X, 252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No252Y00000XAgenciesEarly Intervention Provider Agency